Meet Rachel – a horse with two names

Rachel David is a practicing mental health counselor, interested in gender, sexuality and cross cultural perspectives. During her masters studies, she specialized in industrial psychology and counselling and is interested in creating safe spaces in and around herself. Rachel taught at Mount Carmel College, Bangalore, before she moved to Dehra Dun where she currently lives (and hibernates). 

I asked Rach a few questions around the subject of mental health and well-being.

Are there self-evaluative ways to tell if an individual is mentally healthy? We seem to have ways to do this with the body, somewhat…

I think, just like with the body, we get to set our own standards of health that we strive for. Some may want to exercise every day, while others may only do it once a week or lesser than that. Just like with the body, there are also different ways to exercise, practice and evaluate mental health.

I would say that functionality in your everyday life is a good indicator of mental health. Of course we all have our off days but on an average if you are able to be functional in your own spaces of work, home and social circles it is usually a good indicator of mental health. And of course there are a myriad of conditions that are an exception to this rule of functionality but it usually serves as a good first measure.

Mental health is incredibly complex as it often transcends the biological and moves into a social space. So, in order to be able to fully define mental health we would have to look, not only at the healthy ways in which the chemistry of our minds should work, but also look into what we as a society sees as healthy and unhealthy social interactions.

Fortunately or unfortunately mental health is still something that cannot be quantitatively measured, thereby making its evaluation more difficult and subjective. This, I think makes it very complex as there are many factors that now need to be taken into consideration such as culture and socialization.

Our understanding of the workings of the body arise from the very majorly accepted, modern scientific perspective, which gives us clear directives for when a body is considered healthy or unhealthy. There are signs that you can look for and sugar levels that one can measure. When a body is ill, we more often than not seem to know that something is off. We feel the discomfort that comes along with illness, listen to the signs and take steps to improve our health. In the same way, if we truly listen to how we feel, we know when something is not right.

Just like the body, the mind too gives us signs of illness, these could be physically manifested or manifest in the way that we interact with other people or even with ourselves.

What are the biggest barriers or gaps in people accessing care towards their mental health, in urban settings?

To me, the barriers that prevent access to mental health are both physical and mental. One of the more prominent physical barriers that prevents us from openly accessing mental health is its lack of visibility. For centuries dealing with the mental ill or mentally unhealthy has always been something that was done away from general society. And so the treatment of mental illness along with the illness itself was not always visible. This lack of visibility has remained, making it difficult for us to know how or where to find help and support.

In the last few years, there have been more attempts to make access to mental health more visible, such as providing mental health care in schools, colleges, work spaces and hospitals and we hope that this visibility will continue to grow so that seeking out mental health care can be as easy and accessible as any other service.

Once these spaces have been made visible, the next barrier is that of accessibility. Especially in urban settings where cities are expanding at such a fast rate, being able to reach a mental health care service provider may be difficult. It already takes a lot to go and seek out mental health care and the problem of time or distance may be the last straw that prevents a client from continuing to seek out the service.

Then, there are mental barriers that prevent access to mental health. Some are barriers that arise from our own minds and others may be those put in place due to the stigmatization of mental health in the society as a whole.

Acceptance is the first step as my mother always says! Reaching a point with our own selves where we come to accept that we would benefit from mental health care and seeking out help is what I think is the largest barrier to accessing mental health. It is not always easy to admit to ourselves that we may need help and society had not always made it easy for us to reach this point of acceptance.

Vulnerability is often seen as weak from many schools of thinking and unfortunately we do not yet live in a world where showing this vulnerability will be met with kindness and care. They fear of being ridiculed or shunned from the group may often stand in the way of us seeing and accepting our own need for help. Once we as individuals and as a society learn to accept that the need for mental health care is not very much different from the need for physical health care we would automatically create systems and spaces where it would be more accessible.

We are in a time of transition, where we have realized that we no longer want to stigmatize mental illness or the seeking out of mental health care but unfortunately we are not fully there yet.

We are willing to spend time and money going to parlours to get hairs removed from the surface of our skin, our hair bleached and dyed into all different colours, paint our nails and fix our eyebrows because society has somehow agreed that we need to invest into the upkeep of the physical. I think we are on the path to now accepting and seeing that we need to invest just as much, if not more into upkeep of the mental as well. (this is just so I could vent about beauty standards and the appalling length we have let it reach. So intent on improving the physical and completely ignoring the mind!)

Is it necessary to make a distinction between mental health and mental illness? Why/why not?  At what point is being not being fully healthy, mentally, considered an illness?

It is in our nature to differentiate and from this differentiating find a sense of understanding of the nature of things themselves. Often what makes something what it is, is understood from defining what it is not. In much the same way we try to understand what metal health is by trying to differentiate it from what would be considered mental illness. To me, mental health and mental illness are just different points on a spectrum. The rules or guidelines that we use to separate one from the other arise out of different contexts and societal and cultural understanding.

From a clinical perspective, the guidelines to what could be defined as mental illness are found in books like the DSM (The Diagnostic and Statistical Manual of Mental Health) or the ICD (International Classification of Diseases). These manuals try provide guidelines to help diagnose mental illness. Factors such as presentation of symptoms, duration of symptoms, and alterations in social interaction and functioning could help to further our understanding of when an individual is no longer just mentally unhealthy but crosses over into what could be clinically diagnosed as a mental illness.

A simple fever that presents could be a symptom of a mild infection that the body will take on its own or a symptom of something much larger. Similarly it is important to explore symptoms that might present themselves over long periods of time as it could indicate the need for more care. Much like when you go to a doctor to get a formal diagnosis of an illness that you might have, getting a diagnosis for mental illness can help the individual better understand the nature of the problems and help their support systems to better care for them.

Are there incurable mental illnesses? If so, how can create space for people living these conditions?

Yes, of course. There are many kinds of mental illnesses that are considered ‘incurable’. Most of these arise out of a difference in biological factors that cannot be reversed. Although there is no ‘cure’ for such kinds of illnesses we can provided systems and spaces where individuals with these illnesses can be understood and cared for.

Earlier, individuals with mental illnesses were shunned from society and grossly misunderstood. As we have furthered our understanding of mental illnesses, we have also tried to create ways in which people with these illnesses can interact with and often play a functional or semi-functional role in society.

The best way that we can create a space for this is to first understand the nature and limitations of the illness. Once we have this understanding we can create spaces in our homes, schools and work spaces where limitations are minimised and each individual’s potential is actualized.

Now with the internet and our access to knowledge it has become much easier to equip ourselves with the knowledge and sensitivity that we need. It has also provided access to other individuals and care-givers who may have similar experiences and helped to build a community that can create an ideal environment for people living with different kinds of mental health issues

What are the best ways in which we can help each other without a mental health professional? At what point does professional help and further, clinical intervention, become necessary?

Ideally mental health and its maintenance should be something that we practice with ourselves and with those around us. Finding ways that allow you to feel mentally healthy, finding people with whom you can interact with and share your experiences are an important part of how we live and socialize and also plays an important part in mental health and its upkeep. However this is not always easy. We have not been taught the ways in which we can practice mental health and this lack of understanding of our own mental health, stands in the way of us helping each other.

A mental health professional could help and direct and individual to discover the ways in which they can practice their own mental upkeep and slowly through these learning, hone skills that can be used first on the self and with others that they interact with.

Clinical intervention is necessary when the illness starts to eclipse everyday functioning. As previously mentioned the clinical perspective uses certain guidelines to clinically diagnose a mental illness and provide the necessary intervention.

What models do you see as being most effective today, in understanding and dealing with our mental health and well being? (community driven, clinical… a combination…?)

India and its traditionally family systems, provided spaces where the family and the community could come together and support each other though times of difficulty. However, the lack of understanding and knowledge about mental health and its importance has often led to a great deal of misunderstanding.

Community based approaches can be very helpful in dealing with problems of mental well-being if it is coupled with training and understanding.

The clinical approach to mental health has also had its own missteps. In the past, asylums and institutions where those suffering from mental illness were experimented on and tortured are all part of its history.

Ideally, a combination of both community based approaches as well as clinical approaches each bringing with them their own learnings and experiences should be used to understand and deal with mental health and well-being. It is important to look at the mistakes that were made in the past from both approaches and learn from them so that we can ultimately create a holistic system where mental well-being is cared for from all sides.

However, in the Indian context, I do think that community based approach do have an important role to play in changing the way mental health is looked at and paving the path for clinical intervention if and when needed.

As a young practitioner, what are your biggest challenges in the field?

There are many challenges that I face as a young mental health practitioner and I shall try to limit my answer to the few that are at the top of my mind.

I do think that managing my own mental health and well-being is the largest challenge that I face. It is not always easy to practice what I know and understand theoretically. I often find it difficult to be patient with myself and do not give myself the room to express my own emotions. I do feel that if I am to be an effective and authentic counsellor that I should be able to practice what I have learnt. However this is a lot to expect and I often struggle with these feeling of inadequacy.

Another major challenge that I have faced is finding a mental health professional for myself. As I have just moved cities, it has become difficult for me to find a guide and therapist with whom I can share my own shortcoming and fears. I think it is very important for a practicing professional to have a guide and to be in therapy themselves. However this is something that I am still trying to find for myself, making it one of the bigger challenges that I have had to face.

The scope of psychology is so vast and perspectives so varied that it is often difficult to find and sharpen the techniques that you feel that you should use. I think there are so many ways to try and understand behaviour that there really is no end to learning about new techniques and perspectives. Finding methods that work for both me and my clients is something that I find challenging.

Since I started my journey with mental health it has always been from an academic space. I studied the subject for eight years and then taught it for another two. Because of my exposure to mental health from purely academic spaces it is sometimes a challenge for me to break out of this and realize that real life is not quite as theoretical.

Although I do see the limitations that my age and inexperience bring with it, I know that the only way through it is time and life experience. I have had already had many experiences in my own life that have taught me a great deal about myself and my own mental well-being and I look forward to many more!

Rachel can be contacted on estherdavid.mcc@gmail.com

Yes, her official name is Esther, thanks to parents who liked different names and couldn’t agree on one and so decided to give her a different name on paper from the one they actually use. Think if it almost like a nickname, but with a personality of its own.

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